by Kimberly Allen, RN
Stasis ulcers are also known as venous ulcers. They are a type of wound that develops because the veins in your leg are unable to return the blood back to your heart, which is called venous insufficiency. These types of wounds can significantly impact your quality of life, especially your mobility and ability to perform regular activities of daily living. They are the number one cause of chronic non-healing wounds as they are responsible for up to 90% of all chronic wounds. They can take up to 1 to 2 years to heal depending on the severity and approximately 15% of them will never heal. Not only do skin ulcers heal slowly in approximately 70% of stasis ulcer cases they are reoccurring ulcers.
There are 2 major causes of stasis of stasis ulcers. The majority develop as a result of chronic progressive disease like diabetes that significantly impair lower extremity circulation while others develop after a person has had a deep vein thrombosis. In those with a deep vein thrombosis stasis ulcers tend to develop more rapidly then in those that develop stasis ulcers secondary to a chronic disease.
Our veins have tiny one-way valves spaced through out our veins that keep the blood flowing back up to the heart preventing it from going backwards. When the valves become damaged due to disease or injury they are unable to function properly and the blood then backs up and pools in the vein. The blood almost always pools in the lower legs and ankles, it can even leak out of the veins into the surrounding tissues which in turn then causes the tissue to become damaged leading to the development of a stasis ulcer.
There are several different types of stasis ulcers. Arterial venous ulcers also called ischemic ulcers, which are caused by poor circulation in the arteries. The most common are diabetic or neurotrophic stasis ulcers which are caused by high blood sugar levels. Then there’s vasculitis ulcers which are mostly found in people with chronic inflammatory diseases like RA and lupus. There are also stasis ulcers that develop because of an injury to your leg known as traumatic stasis ulcers as well as those that develops as the result of a tumor called malignant stasis ulcers.
Usually the first indication that you have a stasis ulcer developing is the skin over the area where the blood is pooling becomes dark red to purple. It also tends to become thick, dry and itchy. This is what is referred to as a stage I ulcer. As the ulcer progresses to stage II your leg will become more swollen with increased redness as well as blistering and superficial loss. Left untreated the tissue then becomes necrotic or dead through all the layers of skin exposing the fatty tissue underneath, which is stage III. As the necrosis or death of tissue progresses muscle tissue becomes exposed in stage IV. In stage V the muscle tissue has become necrotic. The last stage is stage VI. This is a very severe ulceration that goes all the way to the bone and begins to destroy the bone tissue, by this time symptoms of sepsis usually develop as well.
There are a variety of ways to treat leg ulcers and newer improved treatments are becoming available regularly. These type of wounds pose a significant challenge to the Doctors and nurses that treat them. I have assisted in treating numerous stasis ulcers over the years and it never ceased to amaze me how long it took for them to heal and many diabetic stasis ulcers simply refuse to heal completely even after years of treatment.
The best way to prevent stasis ulcers is if you’re a diabetic keep your blood sugar under control as well as exercise. Yes, exercise, walking strengthens your calf muscles promoting good venous return. For diabetics and people with other chronic issues doctor’s frequently prescribe the use of compression stockings which are also referred to as TEDS stockings. These stockings will help prevent a stasis ulcer from developing or reoccurring. If you have had a stasis ulcer it’s important to wear these stockings everyday for a minimum of 5 years after the ulcer has healed to prevent it from reoccurring.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.